Female-initiated methods
Mantell JE, Stein ZA, Susser I. Women in the Time of AIDS: Barriers, Bargains, and Benefits. AIDS Educ Prev. 2008;(2):91-106.
Mantell and colleagues comment here on the implications of new HIV prevention technologies (physical and chemical barriers) for women’s health and women’s rights. Four relevant themes are selected that have emerged in the social and behavioural science literature: structural factors (global and national) limiting the availability of female condoms, control and empowerment with female-initiated HIV prevention technologies, covert use of female-initiated HIV prevention technologies, and male partners as part of the bargain for barriers. There is now a rich and diverse literature on all of these issues, relevant and informative, which the authors draw together in this commentary. Discussion of these themes suggests guidelines for policy, research, and action. First, the misconceptions, biases, and prejudices of global and national leaders, including donors, necessitate that we persevere in presenting data to them and engaging them in discussion. Second, we need to support women within their local social contexts to negotiate for their rights, balancing pragmatic approaches to their partners in their initiation of protection, and applying according to each situation as appropriate, a continuum from discretion and clandestine use to deception. Third, men have to be brought in as active participants, and their positive and negative experiences and interests inserted into practices and policies.
Editor’s Note: This thoughtful article underscores women’s need for different HIV prevention methods at different life stages and with different partners. Subsidizing and scaling up female condom programming to overcome access and supply constraints and further trials of cervical barrier methods are urgently needed to make an array of female-initiated protection methods to choose from for all women a reality.
Hoffman S, Cooper D, Ramjee G, Higgins JA, Mantell JE. Microbicide acceptability: insights for future directions from providers and policy makers. AIDS Educ Prev . 2008;20(2):188-202 .
To help fill the gap concerning health care providers’ and policy makers’ knowledge of and views concerning microbicides, Hoffman and colleagues compared data from one U.S. study and two South African studies that explored these issues. Frontline providers in South Africa were enthusiastic about any method that would have the potential to slow the HIV epidemic, whereas providers in New York City and policy makers in South Africa balanced their enthusiasm with more concerns. Across all studies, participants wanted timely and accurate scientific information, and they raised issues about safety, « messiness,», and cost. Many had difficulty understanding that promoting a partially effective method can reduce risk if a client uses it more often than a highly effective method. Microbicide advocates need to effectively communicate to providers the evidence-based findings from microbicide trials and find approaches to introduce concepts such as « harm reduction » and « prevention equation » perspectives in client counselling. Developing these approaches will maximize the positive influence that providers can exert on user acceptability of microbicides once they become available.
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